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What is a Mole?

Moles are one of the most common reasons that patients consult a dermatologist, like Dr. Michele Green.  Dr. Green is a specialist in mole removals both for cosmetic reasons, as well as concern for possible skin cancer.  Dermatology is a broad field which encompasses identifying and removing many different kinds of skin growths, including common moles, nevi, skin tags, and skin cancer.  In general, a moles or  nevi, are benign growths, which are typically light brown in color. Moles can be flesh colored, light brown, blue, or dark brown.  The darker the mole, the more melanocytes it contains.  Dr. Green will be able to examine your moles and determine if any of the moles need removal or a skin biopsy.

When Does a Mole need to be Removed?

A mole may need to be removed, based on examination, if it appears suspicious.  A mole which has irregular color or irregular borders may need a skin biopsy to determine what type of mole it is.  There are benign moles and there are cancerous moles as well.  A trained dermatologist, like Dr. Michele Green, will determine based on the size of the mole, the location of the mole, and its characteristics, whether the mole needs to be biopsied and sent for histologic examination. There are different ways to remove moles, depending on their characteristics.

What is the Best Way to Remove a Mole?

There are several different mole removal procedures based on their size and structure.  There are several different mole removal methods, as they are based on the nature of the mole, they can be removed through four different techniques.

Shave Removal:

A mole can be removed with a scalpel though a shave removal  The surface of the skin is removed and the surface of the mole is shaved and the tissue sample is sent to the laboratory for examination. The benefit of this type of mole removal is that there is generally no scar.  A sufficient about of tissue is removed to make a histologic diagnosis and it should heal well within a week. The benefit of shave removal is that there are no stitches involved, a small scab, and generally faster healing.

Surgical Excision:

A mole can be removed through surgical excision. A surgical excision is generally reserved for a mole or skin cancer which is large or needs to be removed more deeply.  Sutures are used for this type of mole removal procedure.  Typically, many of these cases are referred to a plastic surgeon for surgical excision. This mole removal method takes longer to heal, and again, is dependent on the size and type of mole or skin cancer involved.

Electrodessication:

Some benign moles or growths, such as seborrheic keratoses, can be removed efficiently though the process of electrodessication.  Electrodessication is the process of destroying the lesion through cautery or heat.  Benign lesions can be destroyed in this manner, when skin tissue is not need to send to pathology when the lesion is benign. Alternatively, some skin cancers such as Basal Cell Carcinomas and Squamous Cell Carcinomas can be treated and removed through curettage and electrodessication.

Laser Removal:

Laser removal of moles is not considered by dermatologists to be a good option for mole removal for two reasons.  First, the laser cannot penetrate deep enough to remove the lesion.  Secondly, there will be no tissue sample to enable your dermatologist to test the lesion if there is concern whether or not the lesion is benign. Laser removal should be utilized for sun spots, age spots, wrinkles, port wine stains, Nevus of Ota and other benign lesions.

Liquid Nitrogen:

Liquid nitrogen is used to freeze off benign lesions, actinic keratoses or pre-cancers. Like lasers, you need to be certain the lesion(s) are benign since no skin biopsy is taken in this process.

What is the Mole Removal Procedure for a Shave Removal?

  • Depending on the size and location, photos are taken of the mole which will be removed and the area and size of the lesion documented.
  • The mole which will be removed is marked and the area cleaned with alcohol or other surgical disinfectant.
  • The area is then numbed with a local anesthetic such as lidocaine with epinephrine. The type of lidocaine used is short-acting, and the area should feel numb right away. The epinephrine causes vasoconstriction and reduces any unnecessary bleeding during the removal process.
  • A sterile scalpel is used to shave the mole flush to the skin.
  • The mole removed is sent to the pathology laboratory for examination.
  • If there is any additional bleeding, the area is cauterized with a hyfrecator, or electric needle.
  • The wound is cleaned with hydrogen peroxide and covered with bacitracin ointment and a bandage.  If the patient is allergic to bacitracin, Aquaphor is used in place of bacitracin ointment.
  • Written post-procedure instructions and given to the patient when you leave the office.
  • Dr. Green will call you in one week with the pathology results of the tissue sample from the biopsy or mole removal.

If additional follow-up is needed, Dr. Green will schedule your follow-up appointment or skin exam.

Which Types of Mole Removals Require Stitches?

Depending on the size and cosmetic concerns, some moles need to be surgically removed. In addition, some atypical moles or skin cancers require surgical excisions.  When this type of plastic surgery is needed, it is best to consult a board certified plastic surgeon to help improve the cosmetic outcome and give you an optimal scar.

The plastic surgeon or Moh’s surgeon (skin cancer surgeon) will mark the treated area, clean it, numb the area with local anesthesia, and use a scalpel to excise the mole with a border surrounding it.  The size of the margin depends on both the anatomic location and the degree of atypia or skin cancer. With skin cancers or atypical lesions, the border must be large enough to ensure complete removal. Stitches may be placed both superficial and deep if it is a large, deep, excision.  The outer sutures are removed in approximately 10 days, depending on the area of the body. Special care must be used to keep the excision clean after surgery and not to do any unnecessary exercise which might interfere with the wound healing.

If an excision is required, you may be asked to discontinue blood thinners, aspirin, Motrin, Alleve, multivitamins, herbal supplements, or any other medications which could prolong bleeding and delay wound healing and clotting.

What at home care and home remedies are used after mole removal?

  • After the procedure you need to keep the area clean by providing a layer of Bacitracin ointment or Aquaphor on the wound with a bandage covering the wound.
  • You need to clean the wound twice a day with hydrogen peroxide or sterile water.
  • After cleaning the wound, it is time to apply more ointment and a new dressing.

This process needs to be repeated for one week or longer if stitches are involved until the wound is healed.

Myths about wound healing

  • One important myth about wounds is that you should let the wound “dry out” or “air out”.  It is definitely not true that the open air helps to heal wounds.  While wounds might scab up faster if left uncovered, they heal better if left covered with a layer of ointment to help the wound granulate and heal.
  • Topical Vitamin E often delays wound healing and doesn’t improve it.
  • Taking oral supplements will heal the wound faster.  Some oral supplements also inhibit wound healing.

What follow-up is needed after mole removal?

Follow-up is needed to review the results of your biopsy.  If the histology of your mole is atypical or cancerous, further surgery may be needed.

If the mole is a skin cancer, Dr. Green will recommend a complete skin exam since it is more common to have another atypical mole or skin cancer which may have been out of view.

Stitch removal is required for an excision.  Sutures of the face or ears are generally removed in five days.  Sutures on the body may be removed in approximately 10 days, as the skin is thicker on the body than the face, and generally takes longer to heal.

What over the counter products and skin care creams are available to use at home with scars?

Scar Guard, Mederma advanced scar gel, Kelo-cote, Cica-care gel sheets, Advanced Formula Scar Gel, Cineosil Scar and Laser Gel, among others, can all aid in wound healing. These gels provide a protective coating which helps in wound healing. Dr. Green often recommends simply using Aquaphor as a cost efficient method for wound healing.

Why Do Some People have Moles?

Some people are born with moles, which are referred to as congenital moles. Other people develop moles later in life.  Sun exposure may contribute both to the number of moles and the development of atypical or dysplastic nevi.  It is though this increased UV exposure, whether it be via direct sunlight or tanning beds, that increases the risk of these moles developing more atypia and developing into skin cancers, such as melanoma.

Source: Cancer.gov

How do I know which moles need to be removed?

If you notice a new mole that wasn’t there before or a mole that has changed color, you should consult your dermatologist.  Generally speaking, a mole larger than a pencil eraser, should be evaluated by your dermatologist. The presence or absence of hair doesn’t always predict if a mole is benign.  If there is hair in a mole, it is best to have the mole analyzed before proceeding with hair removal. If there is concern, a tissue sample should be performed and sent to the laboratory for examination.

If you see a very dark, or black mole, the concern is that it might be a malignant melanoma or other atypical mole.  These types of moles can metastasize and affect long term survival and it is urgent if you see a black mole to consult your dermatologist immediately and have a complete skin exam.

Why do I need sunscreen for my moles?

Moles can change in color and become more atypical, or dysplastic, over time.  it is important to use sunscreen, on a daily basis, and minimize sun exposure when you are outside.  Dr. Green recommends a sunscreen of SPF 30 or higher which provides both UVA and UVB protection. Proper use of daily sunscreen can protect you from skin cancer and the damaging effects of UV rays on your skin.

Where can I find more Information on moles?

There is a great deal of information now available on line, through google, about the different types of moles.  In addition your dermatologist, like Dr. Michele Green, should have pamphlets available for you to read on nevi (moles), skin cancer, and the changes that you should look for in a new mole or changing mole.  In addition, there is a great deal of information on moles via the american academy of dermatology (aad.org), the mayo clinic’s website, as well as the skin cancer foundation’s website.

Mole removal before and after photo

3 weeks after treatment with Electrodessication (for removal of cosmetic moles)

Dr. Green is an active member of the Skin Cancer Foundation Society and regularly donates her time for skin cancer screenings. She believes that prevention and early diagnosis saves lives. Dr. Green studied with the late Dr. A. Bernard Ackerman and authored a significant paper with him regarding melanoma, and continues to stay active and informed about treatment options for her patients.

As featured on TV with Dr. Max Gomez, Dr. Michele Green starts every visit with a skin cancer exam to save lives. She recommends annual skin exams to all patients, regardless of skin color or complexion. If you have a history of skin cancer or dysplastic nevi, she encourages more frequent skin examinations.

If you’re concerned about the appearance of new moles, or a changing mole, please don’t wait to schedule an appointment. Contact us online today or call 212-535-3088 to learn more about mole removal from our New York City practice.

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